MCP, easy as 1, 2, 3

GP practices need to start thinking about how they will work with newly forming multispecialty community providers. Samir Dawlatly outlines their options

Multispecialty community provider, or MCP, is one of the new three letter acronyms on the block, along with STP (sustainability and transformation plan), ACO (accountable care organisation), and PACS (primary and acute care system). Recently, draft MCP contracts were released so that organisations could begin to think about how they might form.[1] There are three types of contract—virtual MCP, partially integrated MCP, and fully integrated MCP. The BMA gives a summary of the types on its website
[Link]
.

Accepting a fully integrated MCP contract would be akin to a general practice giving up their general medical services (GMS) contract or their primary medical services (PMS) contract for a time limited alternative provider medical services (APMS) contract.

The partial integration MCP contract would mean the creation of an independent MCP, probably involving community and mental health services, acute hospital trusts, social care, and other non-core enhanced services. GP organisations would then keep their current GMS, PMS, or APMS contract and forge integration agreements with the MCP.

The last option is a virtual MCP, which is not really an MCP at all because no new organisation is created. An “alliance contract” is formed between GP providers, community services, mental health trusts, and social care, with the involvement of NHS England local area teams, clinical commissioning groups, and local authorities. A virtual MCP would aspire to the same values and outcomes as a partial integration MCP, but without the organisational upheaval.

Financial incentives

As yet there are no details about how much each type of MCP contract might be worth. I anticipate that there will be increasingly larger financial incentives to form partial or full integration models. Just how large those incentives will be remains to be seen; it may be that a proportion of the payment will depend on how much expenditure in the acute hospitals has been saved.

A financial incentive will be the first of two driving factors for their formation. The second factor will be the belief that MCPs provide better care for patients.

Forming a fully integrated MCP could be akin to placing the future of your practice outside of your control, and it remains to be seen whether partially integrated MCPs will be in the interests of GPs and their patients or simply in the interests of those that establish the MCP.

It is also not clear how much input or control a GP organisation would have over a partially integrated MCP. A strong, vocal, and vibrant GP organisation may have the ability to make sure that a virtual MCP contract was designed to suit both the patients and GPs involved.

What’s in it for us?

The big question is, “Should my practice be aiming for an MCP?” The answer depends on many things. Firstly, will it mean that your patients get better care? If you don’t believe that they would, then don’t consider one. Secondly, you may be better off in an at-scale organisation that can negotiate a favourable alliance contract as part of a virtual MCP. Thirdly, being part of an MCP of any sort will mean working differently, perhaps with an increase in workload, and so the financial recompense has to make it worthwhile.

Better care for patients and increased funding are the potential carrots to entice GP practices and organisations into MCPs, with the hope that they will also save the NHS money. The elephant in the room, however, is that the stick that may also be used.

That stick is potential changes to the existing GMS contract once MCP contracts have started. It may be that GMS contracts remain unchanged and practices that don’t join MCPs can continue to battle with the usual issues of funding, workforce, and demand. My fear is that the national contracts will be defunded—the government has shown its willingness to play hardball about contract changes—thereby making it unviable for practices to exist alone, without an MCP contract. Choices and influence at this stage are likely to be limited. Beggars can’t be choosers.

Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare the following interests: I am a GP partner at Jiggins Lane medical centre and managing partner and board member of Our Health Partnership. I am the co-clinical director of the QCAPS referral management scheme for Northfield Alliance Ltd. The views expressed here are my own and don’t necessarily represent those of any organisation I work for. I am an occasional member of the RCGP online working group on overdiagnosis.